Meme Kanserinde Uzun Dönem Takip ve İzlem
Synopsis
Meme kanseri, erken tanı ve modern tedaviler sayesinde uzun dönem sağkalım oranları artmış bir malignitedir. Bu nedenle tedavi sonrası izlem ve yaşam boyu takip önem kazanmıştır. İzlemde temel hedef yalnızca rekürrens taraması değil; geç toksisitelerin, sekonder malignitelerin ve yaşam kalitesinin değerlendirilmesidir. Klinik takip sıklığı ilk yıllarda daha yoğundur ve yıllık mamografi meme koruyucu cerrahi yapılan hastalarda devam eder. Tedaviye bağlı geç toksisiteler arasında kardiyotoksisite, pulmoner fibroz, nöropati, kemik sağlığının bozulması ve menopoza bağlı semptomlar yer alır. Aromataz inhibitörleri osteoporoz riskini artırırken tamoksifen endometriyal kanser ve tromboemboli riskini yükseltebilir. Lenfödem, özellikle aksiller diseksiyon ve radyoterapi sonrası gelişebilen önemli bir morbidite kaynağıdır ve manuel drenaj ile kompresyon tedavisi temel yaklaşımdır. Sekonder malignitelerin erken tanısı için kişiselleştirilmiş tarama protokolleri gereklidir. Genetik yatkınlığı olan hastalarda (BRCA vb.) aile taraması ve risk azaltıcı stratejiler önem taşır. Egzersiz, kilo kontrolü ve sigarasız yaşam, rekürrens riskini azaltmada etkilidir. Multidisipliner survivorship yaklaşımı, uzun dönem yaşam kalitesini artırmada temel rol oynar.
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